الفهرس 
Epidemiology of LymphomaOnly 14 pages are availabe for public view
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Abstract
Lymphoma is considered the most common hematologic malignancy in Egypt and accounts for about 8.4% of all new cancer cases annually. During the last decade the development of new drugs for the treatment of hematologic malignancies has come of age. In this study we aimed to evaluate the outcome of different treatment methodologies of lymphoma patients.
In this study 74 Egyptian lymphoma patients with a mean age of 38.6 years (range 18-77 years) were included, 31 of which were diagnosed with Hodgkin’s lymphoma (group I), 10 with indolent NHL (subgroup IIa) and 33 patients with aggressive NHL (subgroup IIb). We studied the impact of different clinical and laboratory risk factors on the OS and DFS of enrolled patients. We also compared the different groups as regards clinical outcome and occurrence of complications.
Hodgkin’s lymphoma patients represented (42%) of the whole patients, while NHL patients represented (58%) of patients. Regarding the male to female ratio, in Hodgkin’s lymphoma patients (group I), the male to female incidence ratio was (1.58:1). The mean age at presentation was (31.4 years) in HL (group I), which was lower than the other 2 groups, (50.9 years) in low grade NHL (subgroup IIa), (41.8 years) in high grade NHL (subgroup IIb), the younger age in group I was associated with less incidence of co-morbid conditions as DM, hypertension and ISHD.
As regards association of HCV infection, the incidence among HL patients (group I) was (6%), and NHL patients (group II) was (18.6%) as detected by ELISA. None were found to be HBV positive among our patients.
Our study showed that there was a high incidence of presentation at an advanced stage disease among all groups of our patients.
• In HL patients (group I) 3.23% of patients presented with stage I, 16.13% with stage II, 22.58% with stage III, 58.06% with stage IV and none presented with stages IIIS or IIIE.
• In low grade NHL patients (subgroup IIa), all the patients presented with advanced stage disease, 10% with stage III, 90% with stage IV, and none presented in stages I or II.
• In aggressive NHL patients (subgroup IIb) 3.03% of patients presented with stage I, 3.03% with stage II, 18.18% with stage III, 18.18% with stage IIIS, 3.03% with stage IIIE and 54.55% with stage IV.
Assessment of the performance status at presentation using the WHO performance status score showed that the percentage of patients with a score 2 or more represented 58.07% in group I, 80% in subgroup IIa, and 42.42% in subgroup IIb.
According to the IPS for Hodgkin’s lymphoma, 54.83% of patients scored ≤ 2, while 45.17% scored ≥ 3.
According to the IPI 48.48% of the patients with aggressive NHL (subgroup IIb) had low risk disease, 39.39% had low-intermediate risk disease, 3.03% had high-intermediate risk disease, and 9.09% had high risk disease.
As regards the protocols of chemotherapy given to our studied patients:
• In the Hodgkin’s lymphoma group (N = 31), 90.32% of the patients (28 patients) received ABVD protocol as a first line therapy, while 9.68% (3 patients) received ABVD plus Involved-Field Radiation (IFR). Assessing the response after finishing chemotherapy showed that 74.19% of the patients achieved CR, 16.13% achieved CRu, 9.68% achieved PR, and no patients had PD.
• For the first line therapy in low grade NHL group (N = 10), 30% of the patients (3 patients) received CHOP protocol, 30% (3 patients) received FC, 40% (4 patients) received COP. Assessing the response after finishing chemotherapy showed that, 3 patients achieved complete remission (30%), 3 patients achieved complete remission unconfirmed (30%), and 4 patients achieved partial response (40%), no patients had a stationary response. Comparing the responses among the three protocols of low grade NHL revealed that, FC was superior to both CHOP and COP that comes in the third place with the lowest responses.
• For the first line therapy in aggressive NHL group (N = 33), 78.8% of the patients (26 patient) received CHOP protocol, 15.15% (5 patients) received CHOP-R, 6% (2 patients) received COP. 9.09% of the patients (3 patients) received Involved-Field Radiation (IFR), while 90.91% (30 patient) didn’t receive. Assessing the response after finishing chemotherapy showed that, 16 patients achieved complete remission (48.48%), 7 patients achieved complete remission unconfirmed (21.21%), 8 patient achieved partial response (24.24%), none had a stationary response, and 2 patients had progressive disease (6.06%). responses to COP were inferior to both CHOP and CHOP-R.
There was a significantly higher incidence of achieving complete response and lower incidence of progression of the disease was found in group I compared to group II.
The overall mortality rate during the period of follow up was (24.3%), (9.68%) in group I, (50%) in subgroup IIa, and (30.30%) in subgroup IIb. (72.2%) of the mortalities were disease related, while (27.8%) were not.
The mean overall survival was (4.74 years) in all patients, (5.51 years) in group I, (2.42 years) in subgroup IIa, and (3.70 years) in subgroup IIb. The 2 year survival rate was (76.5%) in all patients, (90.3%) in group I, (60%) in subgroup IIa, and (69.6%) in subgroup IIb.
The mean DFS was (2.33 years) among the group who performed BMT, and (2.96 years) among the group who didn’t perform.
So, we concluded that ABVD was the standard chemotherapy protocol among our Hodgkin’s lymphoma patients; it was well tolerated, achieving high CR rates. In the low grade NHL group, FC protocol was superior to both CHOP and COP that comes in the third place with the lowest responses. In the aggressive NHL group, responses to COP were inferior to both CHOP and CHOP-R, with the CHOP-R achieving the highest rates of CR.